The objective is to test whether a prescription for nicotine gum aids physician advice against smoking cessation when given to all smokers in the primary practice setting where patients pay for physician visits and prescriptions. The proposed intervention is a randomized clinical trial comparing physician advice and follow-up visit to physician advice and follow-up visit plus nicotine gum in terms of quit attempts and long-term smoking cessation outcomes. Two rural Vermont family practices have agreed to participate. Six hundred adult smokers will be recruited during routine, office visits. Measurements of quit attempts and smoking cessation will be made by various methods including follow-up physician visits at 1-2 weeks, mailed questionnaires to patients and family observers at 2 weeks and 6 months, telephone follow-up in non-responders, and biochemical verification of claimed quitters. The protocal for brief physician advice against smoking (10 min.) has been developed and tested in two previous studies. The prescription for nicotine gum will be accompanied by explicit instructions on its use. The major hypothesis is that the physician advice and follow-up plus nicotine gum group will have higher rates of quit attempts and cessation than the physician advice and follow-up alone group. Secondary hypotheses are that nicotine gum is effective, because it increases intentions to quit, self-efficacy about the smoker's ability to quit, and the perceived physician confidence in giving advice. The major significance of the study is that, if the major hypothesis is true, it will be the first study to show that nicotine gum prompts smokers to quit when used in the primary care setting where patients pay for care and prescriptions. Demonstrating that nicotine gum helps ambivalent smokers may provide an incentive for physicians to engage in cessation advice when they otherwise would not.